In the immediate aftermath of the earthquake in Haiti, AAOS volunteers provided emergency care. Eight months later, the country is still trying to cope with an estimated 25 million cubic yards of debris, as well as with ongoing care of the injured.
Courtesy of Christopher T. Born, MD


Published 8/1/2010

Revisiting Haiti

Returning AAOS members set the stage for the future

Eight months ago, a massive earthquake practically demolished the capital of the island nation of Haiti. The death toll exceeded 250,000, more than 1.5 million were left homeless, and hundreds of thousands of people sustained devastating injuries, many of them musculoskeletal.

AAOS members who were on the island at the time of the quake—and hundreds of others who have since volunteered and served there—were stunned by the devastation, as well as by the determination of the people to continue and to rebuild. The stories they told when they returned to their practices continue to inspire and challenge others.

“An honor and privilege”
Anel M. Abreu, DO,
an osteopathic resident member, served with Mercy Works and the University of Miami/MediShare Tent Hospital. “It was an honor and a privilege to work alongside all the medical professionals, not just from our organization, but from other countries as well,” he said. “It made me so proud to be a member of our community and see people from all corners of the world united and working cohesively toward the common goal of helping as many people as possible.

“Furthermore, I was moved by the stoicism and gratitude of the Haitian people. Despite their desperate situations, they never complained and always made sure we understood how grateful they were for our help. The task at hand is monumental, and it will be years before the Haitian people will live in some semblance of normalcy. My return was conflicted as I wanted to return to my family, but there is so much work still to be done.”

Eric P. Clarke, MD, agreed. He spent a week working at Hospital Espoir with Peter K. Van Patten, MD. “This experience in Haiti was excellent and it impressed me to think about the feasibility of a similar capability in the United States. I was encouraged by and proud of the AAOS volunteers.”

“Haiti could not have pulled through”
Volunteering in Haiti, said David S. Feldman, MD, “is not about doing the ‘greatest’ case or being recognized for saving a limb or a life. There are no surgical heroes in these situations, and this is neither a movie nor a CNN special. We are not discovering the cure for cancer; we are simply contributing a service where we are needed.”

That spirit of service applied to every aspect of caring for the injured. “No matter how senior,” he recalled, “we all changed dressings, looked at surgical wounds, placed IVs, and transported patients.”

The experience changed Dr. Feldman in more than one way. “Previously, I had little to no experience interacting with our armed forces. In Haiti, the U.S. Army maintained order and we worked closely with them. Each soldier I came in contact with was expertly trained, intelligent, disciplined, kind, helpful, and dedicated. The medics operated with us, and they, too, performed the most menial tasks with smiles on their faces.

“Without the tireless work of the U.S. Army,” he said, “Haiti could not have pulled through the first weeks of this crisis. We often forget, due to media reports, how incredible these true patriots are. My attitude and love of these men has been changed forever, and I will support and help them in every way possible.

“The work will continue”
In February, shortly after the earthquake, Kurt Anderson, MD, spent time at St. Damien Hospital, in the Port-au-Prince suburb of Tabarre. With two well-functioning operating rooms and a C-arm, he and other orthopaedic surgeons were performing 10 to 12 procedures each day. But even then, he recognized the ongoing need.

“The work will continue for months with all the second wave procedures that will be required to treat infections, nonunions, and malunions. The ortho team will be there for almost a month, but more will be required during and after that time,” he wrote.

“Although a difficult experience—physically, emotionally, and psychologically—it was one of the most rewarding things I have ever done with my skills as an orthopaedic surgeon,” he said. “The people of Haiti will be forever in my thoughts and prayers and I am sure I will be back.”

Likewise, Kaye E. Wilkins, MD, recognized the difference between the immediate rush of aid and the long-term need for assistance. While serving as part of the CURE team at the Seventh Day Adventist Hospital in Port-au-Prince, Dr. Wilkins wrote, “There has been a lot of excitement during this phase and a lot of dramatic surgery. Unfortunately, a large reservoir of patients will need the less glamorous postoperative care and repair.

“We need to involve the Haitian orthopaedic community in any future plans regarding orthopaedic care of patients in Haiti. We need to assist them in their recovery process.”

From response to development
Two months after the quake, AAOS international affiliate member John Norgrove Penny, MD, served with Handicap International. The acute emergency response is over and Haiti is now into the reconstruction and rehabilitation stage. This demands a development mindset with a longer-term view, staying power, and a sincere commitment to working with and capacity-building national staff,” he said.

Similarly, Courtland G. Lewis, MD, who served at Hôpital Eliazar Germain, in Port-au-Prince, said, “I strongly support an AAOS initiative in Haiti, but I think it is essential to explore the best mechanism to provide long-term education of Haitians within the context of their resources.”

A continuing commitment
The AAOS and its members are continuing their commitment during the reconstruction and rebuilding efforts.
In addition to a $50,000 donation to support ongoing healthcare efforts, the Academy continues to work with the Haitian Orthopaedic and Traumatology Society leadership and with select nongovernment organization partners on the ground in Haiti to determine what is the best and most manageable means to deliver the needed education within the framework of what can be supported locally.

As an immediate start, a comprehensive Electronic Orthopaedic Library, with intellectual property contributions from the AAOS, the Orthopaedic Trauma Association (OTA), and the Pediatric Orthopaedic Society of North American is already available. Orthopaedic organizations interested in adding educational materials to the library should contact Lynne Dowling, AAOS international department.

In addition to helping rebuild orthopaedic physician education efforts, the AAOS-OTA Haiti Relief and Disaster Preparedness Project Team is developing a formal disaster preparedness plan. One aspect of the plan addresses the training and credentialing process for volunteers. Once this process is established, AAOS members—proactively and on an ongoing basis—will be able to qualify as trained responders. This will better prepare and enable the AAOS to help members respond to future heavy orthopaedic trauma injury disasters